The atypical antipsychotic quetiapine (Seroquel) was launched in 1997 and is widely prescribed for the treatment of psychosis and schizophrenia. Although the drug is approved for the treatment of mania in many European countries, its efficacy in bipolar maintenance has not (yet) been established. Considering the excellent safety profile of quetiapine (one of the main marketing messages), it is likely that Astra Zeneca will explore an indication for bipolar maintenance in the future. The overall marketing strategy will probably have a strong emphasis on the drug's clean tolerability profile (no weight gain, no increase in serum prolactin levels, no EPS).

Strengths:

• Proven acute antimanic effect.
• Potential antidepressant effect.
• Reduced weight gain, hormonal changes, and EPS compared with other atypical antipsychotics.

Weaknesses

• Data on maintenance are limited.
• Associated with somnolence and other side effects.